Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome

Objective: To investigate perinatal outcome after endoscopic laser coagulat ion of the placental vascular anastomoses in severe mid trimester twin-to-t win transfusion syndrome (TTTS). Study Design: In a prospective study betwe en January 1995 and September 1999, we performed laser therapy in 200 conse cutive pregnancies with TTTS between 16 and 25 weeks of gestation. We compa red outcome of the first group of 73 pregnancies whose outcome has been rep orted previously in a study comparing laser surgery and serial amniodrainag es [Am J Obstet Gynecol 1999;180:717-24], with the following group of 127 p atients. Results: The overall survival rate increased from 61% (89/146) in group 1 to 68% (172/254) in group 2. The percentage of pregnancies with sur vival of both fetuses was 42% (31/73) in group 1 and increased to 54% (69/1 27) in group 2 (P = 0.142). The survival rate for at least one fetus was 81 % (103/127) in group 2. The median gestational age at delivery of liveborn babies was 33.7 weeks in group 1 and 34.4 weeks in group 2 with a median in terval of 13 weeks between the intervention and delivery. Conclusion: This study of a large population of pregnancies with severe second trimester twi n-to-twin transfusion syndrome confirms the improvements of outcome after l aser therapy as compared to serial amniodrainages reported previously. Furt hermore, it shows a trend towards an increase in survival rates with growin g experience in this technique, most likely attributable to a more selectiv e identification and efficient coagulation of the placental vascular anasto moses. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.